Comparison of dual-antiplatelet therapy durations after endovascular revascularization of infrainguinal arteries.

Abstract

BACKGROUND:

The optimal dual-antiplatelet therapy (DAPT) duration after endovascular revascularization of infrainguinal arteries is uncertain.

METHODS:

This study examines DAPT prescription trends and 12-month major adverse limb events (MALEs; a composite of repeat endovascular or surgical revascularization, acute vessel thrombosis, or amputation of the target limb), major adverse cardiovascular events (MACEs; all-cause mortality, nonfatal myocardial infarction [MI], stroke, or coronary revascularization), fatal bleeding events, and those requiring interruption or discontinuation of DAPT (hemorrhagic complications) for patients enrolled into the Excellence in Peripheral Artery Disease (XLPAD) registry.

RESULTS:

Data on 368 patients prescribed antiplatelet therapy were analyzed; 8.2% were prescribed antiplatelet monotherapy, 48.6% DAPT for ≤3 months, and 43.2% for >3 months. Patients in the >3 DAPT prescribed group were older, had preexisting coronary artery disease (CAD), and prior MI (all P < 0.001). Overall MALE in the ≤3 and >3-month DAPT prescribed groups were 22.3% and 23.9%, respectively (P = 0.541). Survival analysis showed significantly higher rates of MACE in patients prescribed >3-month DAPT (17.6% vs. 9.5%; P = 0.019). An "as-treated" analysis excluded 10 patients who were prescribed DAPT for >3 months and revealed similar rates of MALE (24.9% vs. 20.8%; P = 0.386) and MACE (12.2% vs. 14.8%; P = 0.443) in patients receiving ≤3 and >3 DAPT. Hemorrhagic complications were similar across all prescribed and "as-treated" DAPT groups.

CONCLUSIONS:

After infrainguinal endovascular procedures, patients with underlying CAD were prescribed longer (>3 months) duration of DAPT and experienced more cardiovascular events compared with those prescribed ≤3 months of DAPT. Adverse limb events were similar in both groups.

• Authors: Karan Sarode, Atif Mohammad, Swagata Das, Ariel Vinas, Avantika Banerjee, Shirling Tsai, Ehrin J Armstrong, Nicolas W Shammas, Andrew Klein, Emmanouil S Brilakis, Subhash Banerjee
• Journal: Annals of vascular surgery (Ann Vasc Surg) Vol. 29 Issue 6 Pg. 1235-44 (Aug 2015) ISSN: 1615-5947 [Electronic] Netherlands
• PMID: 26026491 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
• Copyright: Published by Elsevier Inc.

Chemical References

• Platelet Aggregation Inhibitors

Topics

• Age Factors
• Aged
• Amputation, Surgical
• Comorbidity
• Disease-Free Survival
• Drug Administration Schedule
• Drug Prescriptions
• Drug Therapy, Combination
• Endovascular Procedures (adverse effects, mortality)
• Female
• Hemorrhage (chemically induced)
• Humans
• Kaplan-Meier Estimate
• Limb Salvage
• Male
• Middle Aged
• Myocardial Infarction (mortality, therapy)
• Peripheral Arterial Disease (diagnosis, mortality, therapy)
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Practice Patterns, Physicians' (trends)
• Proportional Hazards Models
• Recurrence
• Registries
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stroke (mortality)
• Time Factors
• Treatment Outcome
• United States